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PubMed1991

The logical structure of the VIDEOFAR drug data base.

The quality of the analyses that can be carried out by a Drug Prescription Monitoring System depends on the completeness and accuracy of the information on drugs. Data quality depends also on the organization of the data base that must be designed to allow higher retrieval power with regard to the information level theoretically contained in stored data. Considering these requirements we developed inside the VIDEOFAR project, starting from the preceding experiences at the Istituto Superiore di Sanità, an activity of design and realization of a Drug Data Base whose structure, both logical and physical, is described.

Database Management Systems↗

PubMedDate not supplied

[Community participation. Some perspectives on professional involvement in health programs].

Action Community regarding health is but part of a long-term project started out back in the 1960. As far as Latin America was concerned the so-called experience did not work out; notwithstanding, it has become an Attention-Getter among the countries of the area once again. How so? Because of the Primary-Approach. Understood as an approach based on the global development of society, self-involvement lies at the cornerstone of the whole process. The health section gives full measure of the primary-approach theoretical framework and propose alternatives to get it of the ground. Professionals from the health section aim at "self-involvement" as activity performed willingly. Besides as it were, it should be supervised by experts. Nowadays the venezuelan government promotes action community claiming it will endorse the Primary-Approach on health granted the national health system bill is approved. Amid such context dentistry most meet the challenge of upcoming changes, so must fellow-dentists who, in the end, will dominate center stage. The process must narrow down to actions with will stem from its own dynamics along the way. Needless to say, these actions can not be easily foreseen, let alone do they guarantee success.

Community Health Services↗

PubMed1994

[Evaluation of a primary care self-management project].

OBJECTIVE: To evaluate a "Primary Care Self-Management Project" started in 1992. DESIGN: An observational and semi-experimental study with sub-designs: post-test, pretest/post-test with one group, pre-test/post-test with a non-equivalent control group and multiple temporal series. SETTING: An urban area. PARTICIPANTS: The nine Primary Care teams (PCT) in Vitoria-Gasteiz. INTERVENTION: A decentralised budget for self-management was assigned to each PCT, which included Chapter I, staff replacements and Chapter II, Stores, Laboratory, Radiology and Maintenance. MEASUREMENTS AND MAIN RESULTS: 1. Cost control and adjustment of each PCT to the assigned budget. There was an overall saving of 1.8% of the total decentralised budget (96,959,988 pesetas). Six of the nine PCTs fulfilled their assigned budgets. 2. The increase in professional motivation was partially measured by looking at short-term spells off work in the Absence from Work index. In the PCT this index fell 31% from 1991 to 1992, from 4.2 to 2.9%. Among the County's other staff this index remained practically stable, falling only from 5.1 to 4.8%. 3. Higher productivity and better budget use was measured by looking at replacement costs, which went down 7.2% from 1991 to 1992. The proportion of cost arising from replacements for scheduled activities went from 57.9% in 1991 to 39.1% in 1992. CONCLUSIONS: Self-management, at least within the scope of this study, has positive effects on various aspects of the PCTs' work.

Cost Control↗

PubMed1994

Trends in cerebrovascular mortality and in its risk factors in Finland during the last 20 years.

At the beginning of the 1970s, the mortality rates from cerebrovascular disease in Finland were among the highest in the world. In addition, the levels of the main known risk factors for cardiovascular disease, such as high blood pressure, elevated serum cholesterol level and cigarette smoking, were by international comparisons very high. Within Finland, higher mortality from both stroke and ischemic heart disease was observed in the eastern part of the country, where the levels of the risk factors mentioned were higher than in the western regions. Official mortality statistics show that deaths from stroke in Finland declined steeply in the 1970s, and continued to decline, although at a slower pace, during the 1980s. Furthermore, the decline in stroke mortality was greater in eastern Finland than in the western part of the country, such that the gap observed between east and west Finland in stroke mortality has now almost disappeared. These findings are supported by the trends observed from the North Karelia stroke register and from the FINMONICA stroke register. A cohort study has demonstrated that high blood pressure, high blood cholesterol level and cigarette smoking are risk factors for fatal stroke in the male population of eastern Finland. In women, only high blood pressure was found to be a risk factor for fatal stroke, while for cigarette smoking and high blood cholesterol levels the risk, though increased, was not statistically significant. A national strategy has been developed to control and reduce the main cardiovascular risk factors in Finland. The North Karelia project, started in Finland in 1972, was the first program of its type aimed at the reduction of risk factors in a whole population. Arterial blood pressure and total blood cholesterol levels have decreased significantly during the last 20 years in both men and women. The prevalence of cigarette smoking has been reduced only in men. The changes in risk factors that have occurred parallel the changes in stroke mortality, suggesting that the selected strategy--to reduce risk factor levels on a population-wide basis--has been effective in reducing stroke mortality in Finland.

Adult↗

PubMed1993

Reduced failure rate in knee prosthetic surgery with improved implantation technique.

From the Swedish Knee Arthroplasty project, started in 1975, types of relatively unmodified knee prostheses were chosen for analysis of time-dependent changes in the failure rate. One thousand nine hundred sixty-nine Marmor unicompartmental and 376 Total Condylar arthroplasties, all cemented, were followed until the end of 1989. The cumulative revision rates calculated with survival statistics showed a continuous improvement with time. The five-year revision rate was reduced from 11% to 5% for the Marmor prosthesis and from 10% to 2% for the Total Condylar prosthesis. This indicates that factors other than improved design are important. Such factors could include improved guide instruments, better surgical and cementing technique, influence of a learning curve, and patient selection.

Follow-Up Studies↗

PubMed1993

[Systematic control of claw health in cows raised in loose housing systems for the total year].

Claw health was systematically checked and recorded in the dairy herd of the experimental and teaching unit at Oberschleissheim. The project started in March 1988 and ended in July 1989. In total 158 dairy cows and 50 heifers of the breeds German Black and White as well as German Simmental were examined for claw health at intervals of six weeks. Heel erosion was diagnosed most frequently, followed by interdigital dermatitis and contusion of the sole. Contusions and ulcerations of the sole were located especially in the claws of the hindleg. More than 90 percent of lameness occurred in the hindleg. Frequency and severity of claw disorders were reduced significantly over the 1.5 year period of systematic veterinary supervision of claw health. Thirty percent of dairy cows were diagnosed as having not any claw disorder at the end of the investigation period. The percentage of dairy cows without any claw disorder was increased by 5-10 percent. Cows of the breed German Simmental in their first lactation were a high risk group for contusions of the sole. The repeatability of the claw measurements of angle of the dorsal wall, length of the dorsal wall and of the heel, height of the heel, diagonal length of the claw and ground surface was usually 0.5 and higher. For the claw disorders heel erosion, interdigital hyperplasia and in part contusions of the sole, fairly high correlations were estimated between heifers and cows as well as between consecutive lactations.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1995

[Development and validation of QPD 32, a specific questionnaire for measuring the quality of life of patients with peptic ulcer].

Drugs need to be evaluated both in terms of efficacy, safety and regarding the patient's perception of his own health status. For these reasons, sensible, reliable and patient-oriented instruments are needed, besides the methodologies for evaluation of drug efficacy and safety. Such instruments substantially evaluate Health related Quality of Life (HrQoL). Concerning gastric acid hypersecretion few papers are available, based on HrQoL questionnaires, both general and specific. A research project led us to develop through patients and physicians involvement, a specific instrument to evaluate HrQoL as to the various aspects of the peptic disease. The project started in 1993 through a series of 4 focus groups with gastroenterologists and patients, followed by the preparation of a questionnaire named QPD48. Such instrument was psychometrically validated through a study named Herqules 1, involving 176 gastroenterologists and 1774 patients. The psychometric analysis on QPD48 led to the re-issue of a questionnaire named QPD32 with Chronbach's alfa equal to 0.91, based on 3 factor-referenced subscales evaluating pain, induced anxiety, constrained daily living and awareness of symptoms and agents. Concerning the concurrent validity a one-way analysis of variance showed highly significant differences associated with attack frequency with substantial effect sizes ranging from 0.46 to 1.27 of a standard deviation in the full scale. QPD 32 is patent protected and will be used in clinical trials.

Adult↗

PubMed2007

The process of health visiting and its contribution to parental support in the Starting Well demonstration project.

Significant resources are being directed at interventions designed to attenuate the effects of deprivation on children's health and development. The Starting Well demonstration project, established in two deprived areas within a Scottish city, aimed to show that a programme of planned activities to support families could improve child health. The project was subject to a main quantitative evaluation and several additional qualitative and mixed-method evaluations. The present paper draws on findings from one of the qualitative studies that sought to gain insight into how interventions provided by health visitors were operationalised and how they were perceived by parents. The particular focus of this paper is how the process of health visiting resulted in parents' perceptions of being supported. A longitudinal design captured variation in work undertaken by health visitors and temporal changes in maternal experiences of child rearing. Semi-structured interviews were conducted with 20 mothers and their health visitors at two time points, i.e. when infants were 3-4 and 9-10 months old. Sampling was 'purposive', and included first-time and experienced mothers. The findings reported here are based on 59 interviews carried out during 2002 and 2003. The analysis involved a thematic approach focused on programme implementation, and participant perceptions about process and benefit. Parental perceptions of being supported were exemplified by increased confidence in infant care, reduced anxiety regarding infant care needs, increases in knowledge and sense of personal competence in parenting practices, reduced isolation, and advocacy for those experiencing problems. A selection of the interactional processes that resulted in these forms of perceived support are reported, including methods of providing information, cautious and tactful questioning of maternal decision-making, and encouragement of successful parenting practice. The implications for practice, service delivery and targeting at the individual level are noted.

Female↗

PubMed1999

The AAMFT-Head Start Training Partnership Project: enhancing MFT capacities beyond the family system.

This paper summarizes the experience of a two-year project to promote partnerships between 12 graduate Marriage and Family Therapy (MFT) training programs and their 12 local Head Start partners. The American Association for Marriage and Family Therapy (AAMFT) awarded 9 grants to MFT-Head Start partnerships that had established relationships with each other prior to the project. Three MFT-Head Start pairs that had no preexisting relationship but wanted to develop one received planning grants. The partnership project provided an exciting opportunity for MFT faculty and interns to integrate family systems theory into larger organizational settings and to enhance the capacity of MFTs to serve disadvantaged, low-income, culturally diverse families and the community agencies that work with them. Preparing MFT students to intervene and respond systemically both in organizations and with the families they serve represents a viable alternative to more traditional approaches to MFT that limit the focus to the family system. Survey results and interview data reflect the rich experiences of MFT faculty and supervisors, MFT interns, and Head Start staff. Implementation issues are discussed and recommendations are made to improve the collaboration between MFTs and community-based agencies such as Head Start.

Child, Preschool↗

PubMed2001

Japanese experience of telemedicine in oncology.

We started telemedicine projects from 1990 with a telepathology system within Tsukiji Campus of National Cancer Center. In 1994, we connected Tsukiji Campus and Kashiwa Campus by 6 Mbps optical fiber leased line using IP protocol for data transmission, for teleconference, telepathology, and teleradiology projects. We also started connection of regional cancer centers and are now forming a cancer center network of 14 cancer centers. We are at present organizing 130 teleconferences per year with an attendance of more than 16000 people as summary. We have also used a high-resolution image transferring system, such as SHD (2000 pixelsx2000 pixels resolution) system on one side, and an economical telemedicine system using JAVA and a WWW browser (NCC_image) on the other side. We think that providing information is another field of telemedicine. We began the experimental gopher and WWW service in 1993. We are now providing official up-to-date cancer information for patients and healthcare professionals. We are getting more than 400000 hits per month. We are also providing a teleconference video session which is held every week on the Internet using a Real Video system with synchronized slide presentation on the WWW browser. We are also organizing a Cancer Image Reference Database System including DICOM images with viewer software. This paper is a summary of the telemedicine projects performed at the National Cancer Center.

Community Networks↗

PubMed2005

[Three patients with pneumonia due to Legionella associated with a sauna, a cooling tower and a caravan in The Netherlands].

In three male patients with lower respiratory disease, aged 51, 32 and 63 years, Legionnaires' disease was diagnosed by urinary antigen test and culture of the respiratory-tract fluid. In the second patient, the bronchoalveolar fluid also contained Streptococcus pneumoniae and Haemophilus influenzae. All three patients recovered after treatment with azithromycin in the first, cefotaxime, vancomycin and levofloxacin in the second, and erythromycin and ciprofloxacin in the third, respectively. Legionella pneumophila pneumonia is clinically not clearly distinct from other pneumonias and has a high mortality rate when not treated with the proper antibiotics. For that reason, adequate and swift diagnosis is of great importance. The urinary antigen test meets both of these criteria. Still, it is advisable to use culture and serology as well if Legionnaires' disease is suspected in a patient, since the urinary antigen test has limitations. In addition, patient isolates are ofepidemiological importance for public health. By comparing available patient isolates with Legionella strains from water sources, it is possible to identify sources of infection. In 2002, based on this principle, a project was started in The Netherlands aimed at identifying sources of infection, thereby preventing outbreaks of Legionnaires' disease by swift elimination of the source. Since the start of the project, 29 sources have been identified. In the cases described above these were a sauna, a cooling tower and a caravan, respectively. In suspected cases, respiratory-tract fluid must be collected to make possible such a source investigation.

Adult↗

PubMed2006